Severe sepsis and septic shock at the Hajj: Etiologies and outcomes

Background: The Hajj represents the largest mass migration on earth, during which several million Muslims travel across the planet to descend on specific holy sites at Makkah in the Hijaz area of the Kingdom of Saudi Arabia. Since sepsis syndrome is a major worldwide cause of morbidity and mortality we decided to study the incidence, etiologies, complications and outcome of severe sepsis and septic shock among Hajjees patients in two major intensive care units (ICUs) in Makkah for the Hajj season 2004. Method: A prospective observational study was conducted during the 2004 Hajj season between 8 January and 21 February in two major hospitals in Makkah. Results: Severe sepsis and septic shock accounts for 25.4% of admission to the ICU during Hajj. The mean age of hajjees was 65.45 (+/- 14.0) years. Chronic respiratory illness was the leading comorbidity present in more than 70% of hajjees and pneumonia was the leading cause of sever sepsis and septic shock. Gram-negative organisms were the most frequently isolated pathogen in this subset of patients. Acute renal failure is common among pilgrims who presented with septic shock, and carries high mortality. Conclusion: Septic shock is a major cause of admission to the ICU during Hajj and carries a poor outcome. More studies are needed to evaluate modifiable factors that are associated with this high mortality. (C) 2008 Elsevier Ltd. All rights reserved.